Interventions to slow progression of nearsightedness in children

What was the aim of this review?To find out if there are treatments that can slow the progress of nearsightedness (myopia) in children. Myopia is a vision condition in which people can see close objects clearly, but objects farther away appear blurred.

Key messageEye drop medication, such as atropine, probably slows myopia progression in children. Children taking these eye drops may have blurred near vision, sensitivity to light, and some itching and discomfort. Multifocal lenses, either spectacles or contact lenses, may also confer a small benefit.

What did we study in this review?During childhood and adolescence, the eyeballs can grow too long and can develop myopia. Treatments can slow growth of the eye, thereby slowing down the progression of myopia.

Cochrane researchers assessed how certain the evidence was for each review finding, factoring in problems such as the ways studies were done, inclusion of very small studies, and inconsistent findings across studies. They also looked for factors that can make the evidence more certain, including very large effects. They graded each finding as very low, low, moderate, or high certainty.

What were the main results of this review?Cochrane researchers found 41 studies of treatments to slow myopia progression. These studies included a total of 6772 children. The review found that the following treatments may slow the progression of myopia, compared with wearing ordinary spectacles.

The review found that the following treatments may have a small effect, or no effect, on myopia progression.

• Spherical aberration soft contact lenses (low-certainty evidence).

• Systematic adenosine antagonists (moderate-certainty evidence).

Children who wear undercorrected spectacles may have an increased chance of myopia progression compared with children who wear fully corrected spectacles (low-certainty evidence). Only very low-certainty evidence on rigid gas permeable contact lenses was available.

Antimuscarinic eye drops may result in blurred near vision, sensitivity to light, some discomfort and itching, and medication residue on the eyelids or eyelashes. Some children may develop small nodules or bumps under the eyelid. Spectacles and contact lenses, if used properly, are safe and effective.

How up-to-date is the review?Cochrane researchers reviewed studies published up to February 2018.

Authors' conclusions:

Antimuscarinic topical medication is effective in slowing myopia progression in children. Multifocal lenses, either spectacles or contact lenses, may also confer a small benefit. Orthokeratology contact lenses, although not intended to modify refractive error, were more effective than SVLs in slowing axial elongation. We found only low or very low-certainty evidence to support RGPCLs and sperical aberration SCLs.

Read the full abstract...

Background:

Nearsightedness (myopia) causes blurry vision when one is looking at distant objects. Interventions to slow the progression of myopia in children include multifocal spectacles, contact lenses, and pharmaceutical agents.

Objectives:

To assess the effects of interventions, including spectacles, contact lenses, and pharmaceutical agents in slowing myopia progression in children.

Search strategy:

We searched CENTRAL; Ovid MEDLINE; Embase.com; PubMed; the LILACS Database; and two trial registrations up to February 2018. A top up search was done in February 2019.

Selection criteria:

We included randomized controlled trials (RCTs). We excluded studies when most participants were older than 18 years at baseline. We also excluded studies when participants had less than -0.25 diopters (D) spherical equivalent myopia.

Data collection and analysis:

We followed standard Cochrane methods.

Main results:

We included 41 studies (6772 participants). Twenty-one studies contributed data to at least one meta-analysis. Interventions included spectacles, contact lenses, pharmaceutical agents, and combination treatments. Most studies were conducted in Asia or in the United States. Except one, all studies included children 18 years or younger. Many studies were at high risk of performance and attrition bias.

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